Biomedical subjects

D G Ashbaugh

Publications and source records attributed to D G Ashbaugh.

At least 19 recordsLinked to original sources

PubMed1992

Tuberculosis and the surgeon.

With the resurgence of active tuberculosis in the United States, surgeons may be called upon to participate in the management of primary tuberculosis as well as major complications of the disease. To define the role of surgery in the diagnosis and treatment of tuberculosis in the 1990s, a 5-year retrospective review of 121 tuberculosis patients requiring invasive procedures in the course of their work-up was performed. Mycobacterium tuberculosis was cultured in 68% of patients, and atypical mycobacteria in 19%. Tissue was required to achieve the definitive diagnosis in 36%. Of the 93 patients with pulmonary evidence of tuberculosis, 54% presented with a pulmonary complication, 19 of whom required operative intervention. Extrapulmonary tuberculosis affected 45% of patients, including nine with miliary tuberculosis. Patients testing seropositive for human immunodeficiency virus accounted for 11% of the patients seen, emphasizing that the re-emergence of tuberculosis is not confined to the immunosuppressed.

Adolescent↗

PubMed1991

One of us.

Explore the source record for details and available documents.

Aged↗

PubMed1991

Reappraisal of emergency room thoracotomy in a changing environment.

The efficacy of resuscitative emergency room thoracotomy (ERT), particularly in blunt injury, has been questioned. Wide application of the procedure may not be cost effective. The risk of exposure and lethal infection to medical personnel during ERT is considerable. For the past decade, the policy at this institution has been to perform ERT on all moribund patients sustaining penetrating torso injury and all patients sustaining blunt injury with any evidence of cardiac electrical activity. To evaluate whether such a liberal policy is currently justified, the charts of all patients undergoing ERT over a 4-year period were reviewed. One hundred twelve patients underwent ERT; 24 (21%) sustained penetrating injury, 88 (79%) blunt injury. The overall survival rate was 1.8%. Penetrating injury had a 4.2% survival and blunt injury 1.1%. No patients with CPR initiated at the scene and required throughout transport survived. In those patients with both blood pressure and spontaneous respirations present in the field, survival rate was 11.8%. Survival rate in patients manifesting sinus rhythm or ventricular fibrillation upon arrival at the ER was 6.4%. No survivors were noted among patients coming to the hospital with an idioventricular rhythm or asystole. The total hospital charges for patients undergoing ERT exceeded reimbursement by $59,565. Screening for HIV and hepatitis could be documented in only two patients; both were negative. Liberal performance of ERT has dismal results, incurs monetary loss, and affords a greater potential for exposure to lethal infection. Emergency room thoracotomy is justified only when vital signs or a resuscitatible cardiac rhythm are present in the field or ER and deteriorate shortly before thoracotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1991

Empyema thoracis. Factors influencing morbidity and mortality.

The effects of delay in surgical treatment and the choice of operation on morbidity associated with empyema thoracis were evaluated in 122 consecutive patients. Patients (71 from a private practice and 51 from an inner-city trauma/indigent care facility) eligible for study were divided into treatment groups of chest tube only (CT = 39) and open drainage (OD = 19), or decortication (DC = 65). Delay in treatment was defined as greater than 3 days from recognition of empyema to CT and greater than 14 days to OD or DC when chest tubes were inadequate or were not used initially. Delay in OD significantly increased total illness (p = 0.023), days until removal of chest tubes (p = 0.037), and hospital stay (p = .048), but did not affect postoperative stay. Delay in DC increased total illness (p = 0.0001), but did not affect other variables. Delay in CT increased mortality from 3.4 percent to 16 percent. Delay did not increase mortality in OD and DC. DC was superior to OD in patients requiring major operation in total illness days (DC = 36.1 vs OD = 106.1) (p = 0.0005), days until removal of tubes (DC = 7.5 vs OD = 78.3) (p = 0.0001), and postoperative stay (DC = 11.6 vs OD = 17.3) (p = 0.018). Overall mortality was lowest in the DC group (6.1 percent). Delay in treatment increases morbidity and DC is more effective than OD in reducing morbidity and mortality when surgical intervention is necessary.

Adult↗

PubMed1985

Idiopathic pulmonary fibrosis in adult respiratory distress syndrome. Diagnosis and treatment.

Ten consecutive patients who presented initially with adult respiratory distress syndrome, and who did not respond to conventional treatment, underwent open lung biopsy early in the course of their illness. Idiopathic pulmonary fibrosis was diagnosed and aggressive treatment with methylprednisolone sodium succinate and nutritional support was initiated. Eight patients survived and have not required long-term corticosteroid therapy. Previous reports have documented a mortality of greater than 85% with this particular syndrome of idiopathic pulmonary fibrosis in adult respiratory distress syndrome.

Adolescent↗

PubMed1977

Benefits of an intensive community surgical audit program.

In addition to educational benefits, an intensive audit program has satisfied Joint Commission on the Accreditation of Hospitals requirements, allowed in-house Professional Standards Review Organization accreditation, increased percentage of surgery performed by qualified surgeons, and led to the establishment of an effective morbidity and mortality conference. Better methods of granting surgical privileges have been developed, and our accumulated statistics have been utilized to assure our local press and public that we are practicing good quality surgery.

Accreditation↗

PubMed1976

Continuing medical education. The philosphy and use of audit.

In 55 audits of 37 topics totaling 5,499 patient records, 94% of deficiencies were in the area of performance, while only 6% occurred in the area of lack of knowledge. In addition to defining problems, audit serves as an educational experience and a stimulus to improve practice.

Education, Medical, Continuing↗

PubMed1975

Traumatic avulsion of the trachea associated with cricoid fracture.

A 15-year-old girl sustained a cricoid fracture, avulsion of the trachea, and bilateral cord paralysis in a automobile injury. An airway was established by intubation, and primary repair was performed on the day of injury. A postoperative stricture was successfully managed by endoscopic dilatation and injection of triamcinolone into the stricture. Function of one vocal cord appears to be returning 6 months after the injury, and the patient is leading an active life.

Adolescent↗

PubMed1974